Aerococcus Urinae Research Articles

Pathology of Coinfection of Mycoplasma hyorhinis and Aerococcus urinae Causing FiBrinous Pericarditis in a Piglet - A Case Report

Fibrinous pericarditis due to co infection with Mycoplasma hyorhinis and Aerococcus urinae is rarely reported in pigs. In this case report, a one-month crossbreed male piglet with sudden death was diagnosed with fibrinous pericarditis based on necropsy, microbiological and PCR assay. The thoracic cavity was filled with large amounts of serosanguineous fluids mixed with fibrins and thickened pericardial sac adhered to the epicardium looked like bread-and-butter appearance. The cranioventral lobes of lungs showed consolidation with fibrinous exudate. Histopathology of epicardium showed fibrocellular exudates and lungs showed hyperplastic changes with congestion. The antigen of Mycoplasma hyorhinis was demonstrated in heart and lungs. Bacteriological analysis of the heart blood and spleen showed the pure growth of Aerococcus urinae. The genomic DNA of heart, lungs and spleen showed positive amplification of Mycoplasma hyorhinis targeting 16srRNA gene. The present case was diagnosed as fibrinous pericarditis in piglet due to M. hyorhinis with coinfection of Aerococcus urinae, which is often overlooked as a risk factor.

The Urinary Microbiome of Older Adults Residing in a Nursing Home Varies With Duration of Residence and Shows Increases in Potential Pathogens.

The community of bacteria that colonize the urinary tract, the urinary microbiome, is hypothesized to influence a wide variety of urinary tract conditions. Older adults who reside in nursing homes are frequently diagnosed and treated for urinary tract conditions such as urinary tract infection. We investigated the urinary microbiome of older adults residing in a nursing home to determine if there are features of the urinary microbiome that are associated with specific conditions and exposure in this population. We were also interested in the stability of urinary microbiome over time and in similarities between the urinary and gastrointestinal microbiome. Urine samples were prospectively collected over a period of 10 months from a cohort of 26 older adults (aged >65 years) residing in a single nursing home located in Central Massachusetts. Serial samples were obtained from 6 individuals over 10 months and 5 participants were concurrently enrolled in a study of the gastrointestinal microbiome. Information collected on participants included demographics, medical history, duration of residence in the nursing home, frailty, dementia symptoms, urinary symptoms, antibiotic treatment, urinary catheterization, and hospitalizations over a 10-month period. Clean catch, midstream urine samples were collected and stored at -80°C. DNA was extracted and 16S rRNA gene sequencing was performed. The length of stay in the nursing facility and the Clinical Frailty Scale correlated with significant changes in microbiome composition. An increase in the relative abundance of a putative urinary pathogen, Aerococcus urinae, was the largest factor influencing change that occurred over the duration of residence.

MP35-10 NEXT-GENERATION SEQUENCING APPEARS TO RECHARACTERIZE BIOFILM FROM INFECTED PENILE IMPLANTS: HAVE WE BEEN WRONG?

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia (MP35)1 Sep 2021MP35-10 NEXT-GENERATION SEQUENCING APPEARS TO RECHARACTERIZE BIOFILM FROM INFECTED PENILE IMPLANTS: HAVE WE BEEN WRONG? Paul H. Chung, Erica Mann, Joon Yau Leong, and Gerald Henry Paul H. ChungPaul H. Chung More articles by this author , Erica MannErica Mann More articles by this author , Joon Yau LeongJoon Yau Leong More articles by this author , and Gerald HenryGerald Henry More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002044.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Next-generation sequencing (NGS) may provide deeper insight into the biofilm of infected penile implants. Historically, gram-positive skin organisms were most commonly thought to contribute to implant infection. We hypothesize that biofilm detected on penile implants removed due to infection constitute different organisms than those on devices removed for mechanical failure. METHODS: An IRB-approved retrospective review was performed of patients who underwent penile implant removal at two institutions. At time of explant, devices were swabbed with sterile gauze which was sent for NGS testing. Molecular testing of 16s ribosomal RNA was performed by NGS using an Illumina MiSeq sequencing platform (San Diego, CA). Variable regions 1-2 of 16S rDNA gene were amplified and prepared into libraries for sequencing using primers 28F and 388R. Organisms present at <2.0% abundance were considered rare and not included in summary analyses. RESULTS: 95 total implants were evaluated and 52 met study criteria (14 for infection, 38 for mechanical failure). The most prevalent five organisms from each device were assessed. Escherichia coli was one of the top five most abundant organisms of infected and non-infected devices. The other most prevalent organisms on infected devices were Pseudomonas aeruginosa, Enterococcus faecalis, Aerococcus urinae, and Corynebacterium jeikeium. On devices removed for mechanical failure, they were Cutibacterium acnes, Finegoldia magna, Staphylococcus epidermidis, and Burkholderia cepacia. Of the top seven most prevalent genus on implants removed for infection, the ratio of gram positive:gram negative was 5:2 and for devices removed for mechanical indications was 4:3. Common implant antibiotic coatings and dip combinations were broadly reviewed and had similar challenges covering bacteria identified with gentamycin and vancomycin providing the best coverage. CONCLUSIONS: Penile implants removed for infection versus mechanical failure were more pathogenic with organisms different than historically understood. Additional studies will help to further characterize differences and establish whether common antibiotic combinations for prophylaxis, irrigation, and implant coatings should be altered. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e630-e631 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paul H. Chung More articles by this author Erica Mann More articles by this author Joon Yau Leong More articles by this author Gerald Henry More articles by this author Expand All Advertisement Loading ...

Female Urinary Microbiome Analysis and Artificial Intelligence Enhances the Infectious Diagnostic Yield in Precision Medicine

We assessed the diagnostic yield of metagenomics urine sample testing in patients with urological symptoms. We conducted microbiome analysis of 86 female urine samples that included 17 healthy controls and 69 patients. Natural language processing (NLP), a subfield of artificial intelligence, was used to create a pathogen identification tool, Xplore-AI, to assess the potential pathogens in all of the samples. Meanwhile, report summaries that were written by infectious disease experts were compared to the NLP results to investigate its accuracy. The results showed that the NLP system reported 97% of patient samples had at least one pathogen over three standard deviations from values found in in healthy controls. Similarly, 84% of patients had two or more classified pathogens. These diagnostic percentages were consistent with the infectious disease expert summaries. However, some pathogens like Aerococcus urinae were present in 13 patient samples, but only reported in one summary. In conclusion, this study demonstrated the high diagnostic yield in females with urological symptoms following metagenomic analysis and the ability of using an NLP-based system to identify pathogens to improve the accuracy of the reportable species.

A mouse model displays host and bacterial strain differences in Aerococcus urinae urinary tract infection.

ABSTRACTIn recent years, the clinical significance of Aerococcus urinae has been increasingly recognized. A. urinae has been implicated in cases of urinary tract infection (UTI; acute cystitis and pyelonephritis) in both male and female patients, ranging from children to older adults. Aerococcus urinae can also be invasive, causing urosepsis, endocarditis, and musculoskeletal infections. Mechanisms of pathogenesis in A. urinae infections are poorly understood, largely due to the lack of an animal model system. In response to this gap, we developed a model of A. urinae urinary tract infection in mice. We compared A. urinae UTI in female C3H/HeN and C57BL/6 mice and compared four clinical isolates of A. urinae isolated from patients with UTI, urgency urinary incontinence, and overactive bladder. Our data demonstrate that host genetic background modulates A. urinae UTI. Female C57BL/6 female mice rapidly cleared the infection. Female C3H/HeN mice, which have inherent vesicoureteral reflux that flushes urine from the bladder up into the kidneys, were susceptible to prolonged bacteriuria. This result is consistent with the fact that A. urinae infections most frequently occur in patients with underlying urinary tract abnormalities or disorders that make them susceptible to bacterial infection. Unlike uropathogens such as E. coli, which cause infection and inflammation both of the bladder and kidneys in C3H/HeN mice, A. urinae displayed tropism for the kidney, persisting in kidney tissue even after clearance of bacteria from the bladder. Aerococcus urinae strains from different genetic clades displayed varying propensities to cause persistent kidney infection. Aerococcus urinae infected kidneys displayed histological inflammation, neutrophil recruitment and increased pro-inflammatory cytokines. These results set the stage for future research that interrogates host-pathogen interactions between A. urinae and the urinary tract.

POS1159 THE ROLE OF URINARY TRACT INFECTIONS AS A SOURCE OF OSTEOARTICULAR INFECTIONS IN A RHEUMATOLOGY DEPARTMENT DURING THE 2010-2020 PERIOD: A RETROSPECTIVE STUDY

Background:There are several sources of infection in the pathogenesis of osteoarticular infections (OAI). Urinary tract infections (UTI) have rarely been involved whereas skin infection and Staphylococcus aureus represent the classic pair.Objectives:To describe the role of UTI as the source of infection in OAI including septic arthritis (SA) on native joints and infectious spondylodiscitis (SPDI). To compare characteristics of these cases with those of others source and those without any known source.Methods:Medical records of patients aged 18 years old or above who were diagnosed with a non-tuberculous OAI in the department of rheumatology of our hospital during the 2010-2020 period were selected and retrospectively reviewed. The following cases were excluded: SA on prosthetic joint, OIA on surgical material, osteomyelitis, post-operative OAI, SA after joint injection, brucellosis, Lyme disease. Only proven cases where included on the basis of an isolated pathologic organism at the site of OAI infection and/or in the blood (with typical clinical, biological and imaging features). Usually the OAI was considered of urinary source if the same microorganism grew in urine and the OA/blood sample. Cases with probable urinary source were also included on the basis of the type of microorganism and a history of UTI and/or urologic surgery and/or recent antibiotic therapy.Results:95 consecutive cases of proven OAI were included. There were 17 cases (18%) of urinary origin. In 12 cases the same micro-organism grew in urine and OA/blood culture: 5 methicillin sensitive Staphylococcus aureus, 2 Streptococcus Gallolyticus (associated with E. Coli in one case), 1 Escherichia Coli, 1 Klebsiella pneumoniae, 1 Enterococcus faecalis, 1 aerococcus urinae, 1 candida glabrata. Five patients had a probable urine source. In one patient with SPDI and an history of recurrent UTI, blood culture grew E. Coli whereas urine culture grew Enterococcus faecalis. In 4 cases, urine was sterile but a sample (OA in 3, blood in 1) was positive for E. Coli (n=2) or Pseudomonas aeruginosa (n=2).The type of OAI was: SPDI in 10 cases, peripheral SA in 4 cases, both of them in one case and pubic symphysitis in 2 cases. Blood culture was positive in 10 cases and OA sample in 9 cases. Demographics characteristics were: male 59%; age 68.7±11 years. Risk factors were: diabetes 29%; cancer treated with cytotoxic chemotherapy 2 cases; inflammatory disease 2 cases; urological disease and/or recurrent UTI in 59%; immunodeficiency 1 case. Duration of symptoms was 47.1 +/- 50.7 days. Urinary symptoms where present in 29% of patients and fever in 47%. There was no case of infectious endocarditis. Surgical intervention was realized in only one patient. No patient has been admitted in intensive care unit and no patient died. Length of hospitalization was 28±8.5 days. Duration of antibiotic therapy was 13.6±9 weeks. One patient with pubic symphysitis was not cured.The comparison between the group of OAI with urinary source (n=17) and the groups with another primary source of infection (n=52) or no known source of infection (n=26) shows in the first one: a higher prevalence of SPDI (59% vs 34% and 19% respectively), an older age (68.7 years vs 61.9 and 59.7 respectively), a higher prevalence of diabetes or cancer, a longer duration of symptoms (47.1+/-50.7 days vs 21.9+/-29.6 and 22.5+/-25.4 respectively) and a lower mean value of CRP (156+/-135 mg/l vs 182+/-124 and 180+/-140 respectively). A UTI was detected in 76% of OAI of urinary source but also in 13% of other cases (including E. Coli 5 cases).Conclusion:In the years 2010-2020, UTI was responsible for 18% of non-tuberculous OAI as we defined them in this study. A UTI does not demonstrate the responsibility of the microorganism isolated. Thoracolumbar SPDI is the main type. This relatively high frequency has not been reported before and is probably the consequence of the increasing population of aged patients with risk factors and urologic diseases. Clinicians have to be aware of it and prevention is required.Disclosure of Interests:None declared.

Aerococcus urinae : A Rare Cause of Endocarditis Presenting With Acute Stroke

Aerococcus urinae is a rare organism infrequently isolated from cultures. Mostly known to cause urinary tract infection, it can cause bacteremia leading to severe urosepsis and infective endocarditis. Embolization is frequently reported with Aerococcus urinae endocarditis (AUE); hence, the presentation is highly variable. Sequelae such as various central nervous system manifestations, sepsis, valvular regurgitation with heart failure and even coronary artery involvement have been reported. We report a case of a 58-year-old man with AUE of the aortic valve, severe aortic regurgitation and embolic stroke as a result of embolization from AUE and ultimately required aortic valve replacement. Our case highlights this rare cause of endocarditis and offers insight into the variability of patient presentation and risk factors to consider. J Med Cases. 2021;12(2):65-70 doi: https://doi.org/10.14740/jmc3612

Aerococcus-Related Infections and their Significance: A 9-Year Retrospective Study.

Introduction:Aerococcus spp. is a Gram-positive, catalase- and oxidase-negative, microaerophilic, nonmotile bacteria species rarely associated with human infections such as arthritis, bacteremia, endocarditis, and meningitis. The bacteria are also often confused with streptococci species or treated as a contaminant.Patients and Methodology:We conducted a retrospective, observational cohort study on all patients with Aerococcus spp. isolates in blood samples from July 2010 to June 2019. All categorical data were presented as counts and proportions, whereas continuous data were presented as median and interquartile ranges.Results:A total of 20 Aerococcus spp. isolates were identified over the study period of 9 years. Of these, Aerococcus urinae was isolated in 10 (50%), Aerococcus viridans in 6 (30%), and Aerococcus spp. (not speciated) in 4 (20%). The median age was 74.3 years (12 males and 8 females). The two most frequent presentations were fever (15 of 20) and altered mentation (6 of 15). Most of the patients (11 of 15) had at least one predisposing comorbidity related to the urinary tract system (8 with recurrent urinary tract infection, 7 with urinary incontinence, 3 with an indwelling catheter, 2 with renal stones, and 1 each with benign prostatic hyperplasia and a recent cystoscopy). The median white blood cell count was 18,426 cells/mL, median hemoglobin 10.96 g/dL, median platelet count 191,000 cells/μL, median blood urea nitrogen 28.6 mg/dL, and median creatinine 1.54 mg/dL. The urinary tract was the most likely source of bacteremia (10 of 20) based on either imaging findings (5 cases), positive urine culture for Aerococcus spp. (4 cases), or instrumentation history (1 case). In the rest, the cause of bacteremia could not be found. Endocarditis was suspected in 9 out of 20 patients. Transthoracic echocardiography/transesophageal echocardiography (TEE) confirmed 3 cases (2 aortic valves, 1 mitral valve and pacemaker). Interestingly, one case had septic emboli causing a right frontal stroke with a normal TEE and normal Doppler study for deep venous thrombosis. Blood cultures were positive in 35% (7 of 20) with polymicrobial growth, 3 with coagulase-negative staphylococci, 2 with Enterococcus faecalis, and the other 2 each with Diphtheroids spp. and Proteus mirabilis. Of the 20 cases, 9 and 10 required intensive care unit level care and vasopressor support, respectively. Most of the patients were treated for 5–14 days except the 3 cases with infective endocarditis (IE). The median hospital stay duration was 6.55 days with 2 fatalities (2 out of 20 patients).Conclusion:Old age and underlying urologic conditions are the best-known risk factors for Aerococcus spp. infection. Recent advances in diagnostic technology have led to an increase in detection of Aerococcus spp.-related infections. The rare occurrence of Aerococcus spp. in human infections and resultant lack of randomized control trials have resulted in a significant degree of clinical uncertainty in the management of Aerococcus spp. IE.

Management and treatment of Aerococcus bacteremia and endocarditis

ObjectivesWe describe our multicenter experience on diagnosis and management of Aerococcus bacteremia including the susceptibility profile of Aerococcus species and a suggested algorithm for clinicians. MethodsRetrospective study of all patients with positive blood cultures for Aerococcus species from January 2005 to July 2020 in our institution with clinical data and susceptibility profile. Data were collected from both electronic health record and clinical microbiology laboratory database. ResultsThere were 219 unique isolates with only the susceptibility profiles available, while 81 patients had clinical information available. Forty-nine of those cases were deemed as true bloodstream infection and the rest were of unclear clinical significance. Cases of endocarditis (n = 7) were high-grade, monomicrobial bacteremia caused by Aerococcus urinae. Patients with endocarditis were younger (66 vs 80 p < 0.05). The risk for endocarditis was higher if duration of symptoms was longer than 7 days (OR 105, 95% CI: 5−2271), or if there were septic emboli (OR 71, 95% CI: 3–1612). A DENOVA score cutoff of ≥ 3 was 100% sensitive and 89% specific in detecting endocarditis. The 30-day and 3-month all-cause mortality for bacteremia was 17% and 24%, respectively. Six out of seven patients with endocarditis survived. ConclusionsAntibiotic regimen for aerococcal bloodstream infections and endocarditis should be guided by species identification and antimicrobial susceptibility testing. DENOVA scoring system’s performance in this study is more congruent to other studies. Hence, it can be used as an adjunctive tool in assessing the need for echocardiogram to rule out endocarditis. In our experience, two and four weeks of treatment for bloodstream infections and endocarditis, respectively, had good outcomes.

The clinical relevance of pathogen Aerococcus urinae identification by MALDI-TOF mass spectrometry: a case of sepsis in 86-year-old Caucasian male

The infrequency of urinary tract and blood stream infections caused by Aerococcus urinae is most probably due to the difficulties in the identification of this bacterium using standard microbiological methods. With the introduction of more sensitive and accurate techniques in clinical microbiology, such as genetic approaches and Matrix-Assisted Laser Desorption/Ionization-Time Of Flight (MALDI-TOF) mass spectrometry (MS), the incidence of infections due to A. urinae increased. Herein, we described a case of urinary tract and bloodstream infection caused by A. urinae, which occurred in an 86-year-old Caucasian man with a previous history of prostate cancer. The identification of A. urinae was performed by MALDI-TOF MS, since this microorganism cannot be identified by biochemical reactions. In this report, we highlight the need to consider MALDI-TOF MS as technique of choice for A. urinae identification in the presence of subjects with predisposing factors, such as old age, male gender, and genitourinary tract pathologies.

Bladder bacterial diversity differs in continent and incontinent women: a cross-sectional study

Since the discovery of the bladder microbiome (urobiome), interest has grown in learning whether urobiome characteristics have a role in clinical phenotyping and provide opportunities for novel therapeutic approaches for women with common forms of urinary incontinence. This study aimed to test the hypothesis that the bladder urobiome differs among women in the control cohort and women affected by urinary incontinence by assessing associations between urinary incontinence status and the cultured urobiome. With institutional review board oversight, urine specimens from 309 adult women were collected through transurethral catheterization. These women were categorized into 3 cohorts (continent control, stress urinary incontinence [SUI], and urgency urinary incontinence [UUI]) based on their responses to the validated Pelvic Floor Distress Inventory (PFDI) questionnaire. Among 309 women, 150 were in the continent control cohort, 50 were in the SUI cohort, and 109 were in the UUI cohort. Symptom severity was assessed by subscale scoring with the Urinary Distress Inventory (UDI), subscale of the Pelvic Floor Distress Inventory. Microbes were assessed by expanded quantitative urine culture protocol, which detects the most common bladder microbes (bacteria and yeast). Microbes were identified to the species level by matrix-assisted laser desorption and ionization time-of-flight mass spectrometry. Alpha diversity indices were calculated for culture-positive samples and compared across the 3 cohorts. The correlations of UDI scores, alpha diversity indices, and species abundance were estimated. Participants had a mean age of 53 years (range 22-90); most were whites (65%). Women with urinary incontinence were slightly older (control, 47; SUI, 54; UUI, 61). By design, UDI symptom scores differed (control, 8.43 [10.1]; SUI, 97.95 [55.36]; UUI, 93.71 [49.12]; P<.001). Among 309 participants, 216 (70%) had expanded quantitative urine culture-detected bacteria; furthermore, the urinary incontinence cohorts had a higher detection frequency than the control cohort (control, 57%; SUI, 86%; UUI, 81%; P<.001). In addition, the most frequently detected species among the cohorts were as follows: continent control, Lactobacillus iners (12.7%), Streptococcus anginosus (12.7%), L crispatus (10.7%), and L gasseri (10%); SUI, S anginosus (26%), L iners (18%), Staphylococcus epidermidis (18%), and L jensenii (16%); and UUI, S anginosus (30.3%), L gasseri (22%), Aerococcus urinae (18.3%), and Gardnerella vaginalis (17.4%). However, only Actinotignum schaalii (formerly Actinobaculum schaalii), A urinae, A sanguinicola, and Corynebacterium lipophile group were found at significantly higher mean abundances in 1 of the urinary incontinence cohorts when compared with the control cohort (Wilcoxon rank sum test; P<.02), and no individual genus differed significantly between the 2 urinary incontinence cohorts. Both urinary incontinence cohorts had increased alpha diversity similar to continent control cohort with indices of species richness, but not evenness, strongly associated with urinary incontinence. In adult women, the composition of the culturable bladder urobiome is associated with urinary incontinence, regardless of common incontinence subtype. Detection of more unique living microbes was associated with worsening incontinence symptom severity. Culturable species richness was significantly greater in the urinary incontinence cohorts than in the continent control cohort.

Aerococcus urinae - A potent biofilm builder in endocarditis.

The diagnosis of infective endocarditis (IE) remains a challenge. One of the rare bacterial species recently associated with biofilms and negative cultures in infective endocarditis is Aerococcus urinae. Whether the low number of reported cases might be due to lack of awareness and misidentification, mainly as streptococci, is currently being discussed. To verify the relevance and biofilm potential of Aerococcus in endocarditis, we used fluorescence in situ hybridization to visualize the microorganisms within the heart valve tissue. We designed and optimized a specific FISH probe (AURI) for in situ visualization and identification of A. urinae in sections of heart valves from two IE patients whose 16S rRNA gene sequencing had deteced A. urinae. Both patients had a history of urinary tract infections. FISH visualized impressive in vivo grown biofilms in IE, thus confirming the potential of A. urinae as a biofilm pathogen. In both cases, FISH/PCR was the only method to unequivocally identify A. urinae as the only causative pathogen for IE. The specific FISH assay for A. urinae is now available for further application in research and diagnostics. A. urinae should be considered in endocarditis patients with a history of urinary tract infections. These findings support the biofilm potential of A. urinae as a virulence factor and are meant to raise the awareness of this pathogen.

Aerococcus urinae Isolated from Women with Lower Urinary Tract Symptoms: In Vitro Aggregation and Genome Analysis.

Aerococcus urinae is increasingly recognized as a potentially significant urinary tract bacterium. A. urinae has been isolated from urine collected from both males and females with a wide range of clinical conditions, including urinary tract infection (UTI), urgency urinary incontinence (UUI), and overactive bladder (OAB). A. urinae is of particular clinical concern because it is highly resistant to many antibiotics and, when undiagnosed, can cause invasive and life-threatening bacteremia, sepsis, or soft tissue infections. Previous genomic characterization studies have examined A. urinae strains isolated from patients experiencing UTI episodes. Here, we analyzed the genomes of A. urinae strains isolated as part of the urinary microbiome from patients with UUI or OAB. Furthermore, we report that certain A. urinae strains exhibit aggregative in vitro phenotypes, including flocking, which can be modified by various growth medium conditions. Finally, we performed in-depth genomic comparisons to identify pathways that distinguish flocking and nonflocking strains.IMPORTANCEAerococcus urinae is a urinary bacterium of emerging clinical interest. Here, we explored the ability of 24 strains of A. urinae isolated from women with lower urinary tract symptoms to display aggregation phenotypes in vitro We sequenced and analyzed the genomes of these A. urinae strains. We performed functional genomic analyses to determine whether the in vitro hyperflocking aggregation phenotype displayed by certain A. urinae strains was related to the presence or absence of certain pathways. Our findings demonstrate that A. urinae strains have different propensities to display aggregative properties in vitro and suggest a potential association between phylogeny and flocking.

A PECULIAR CASE OF PULMONIC VALVE ENDOCARDITIS

Pulmonic valve endocarditis is a rare entity, accounting for less than 2% of all endocarditis cases, with Staphylococcus and Streptococcus species being the most common culprits. We present a patient with native pulmonic valve Aerococcus urinae endocarditis who originally presented with pneumonia

A case of recurrent aerococcus urinae infective endocarditis with associated cerebral embolic phenomena

Aerococcus urinae is a gram positive, alpha haemolytic cocci that rarely is associated with urinary tract infections, bacteraemia and infective endocarditis. We describe a case of recurrent aerococcus urinae endocarditis with associated cerebral embolic phenomena. A 76 year old man presented with sudden onset right sided weakness and dysphasia. CT and MRI head imaging showed infarcts in the left pons and cerebellum suspicious of embolic aetiology. He had a background of a prosthetic mitral valve replacement following an episode of culture negative infective endocarditis associated with discitis and a psoas abscess 3 years previously. A 16S rRNA PCR on valve tissue had yielded an aerococcus urinae. The anaerobic bottle of a blood culture taken on his present admission flagged positive at 48 hours but no organisms were seen on gram stain. However, Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI – TOF MS) identified an aerococcus urinae 4 hours later. The same organism was also identified in the aerobic bottle which had flagged positive later the same day with gram positive cocci in clusters. Susceptibility testing revealed a MIC (Minimum Inhibitory Concentration) of 0.032, 1 and 8mg/L for penicillin, vancomycin and gentamicin respectively. A transthoracic echocardiogram confirmed reoccurrence of endocarditis with a 1.5cm lesion on the mitral valve. There was no evidence of other embolic phenomena. The patient was managed medically with initial treatment with intravenous vancomycin and gentamicin followed by benzylpenicillin and gentamicin for 6 weeks. The patient made slow rehabilitative progress and remained debilitated by his right sided hemiparesis.

SEPTICEMIA FROM URINARY TRACT INFECTION WITH NEGATIVE URINARY CULTURE: AEROCCOCUS URINAE IN AN OLDER ADULT

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Aeroccocus urinae (A. urinae) is a gram-positive coccus that is known to cause simple urinary tract infections (UTI) in adults. However, it is exceedingly difficult to culture and is often misidentified for streptococci. In this report, we describe a case of an elderly male who presented with septic encephalopathy secondary to A. urinae bacteremia with a grossly positive urinalysis but negative urine cultures. CASE PRESENTATION: A 77-year-old man with a history of hypertension and diabetes who presented to the emergency department with agitation for two days. On presentation, he was oriented to name only and did not follow commands. Initial laboratory assessment revealed a white count of 12,600 U/L, lactate of 2.5 mmol/L and acute kidney injury (creatinine of 1.32 mg/dl). Urinalysis was grossly positive for UTI with turbidity, moderate leukocyte esterase, > 50 WBC, and numerous bacteria. Head CT was negative for acute stroke. Treatment with broad spectrum antibiotics (Vancomycin and Zosyn) was initiated for sepsis presumed to be secondary to UTI. The patient’s agitation worsened despite administration of multiple doses of Ativan and Haldol. The patient remained very agitated and violent so a precedex infusion was started and the patient was transferred to the ICU. Empiric antibiotics were continued as urine cultures remained normal. Eventually the patient’s initial blood cultures turned positive for A. urinae. Surveillance blood cultures obtained following initiation of antibiotic treatment remained negative, and the patient clinically improved over the next few days with continued antibiotic treatment. DISCUSSION: A. urinae is becomingly increasingly recognized as a pathogen causing urinary tract infection and septicemia due to improvements in laboratory techniques (spectrometry and gene sequencing) to isolate the organism. As such, it important to consider A. urinae as a potential pathogen in patients presenting with sepsis with a urinalysis concerning for infection even with negative urine cultures. Risk factors for the disease include male sex, advanced age (>70 years old), and underlying comorbidities, especially urological ones. Beyond complicated UTI and septicemia, Aeroccocus infection can have systemic implications including infective endocarditis, musculoskeletal abscesses and necrotizing urethritis. Fortunately, despite difficulty with isolating the organism, it remains sensitive to most antibiotics including penicillin, but fluroquinolone resistant strains have been reported. Our patient fit the clinical profile reported in the literature and responded well to vancomycin and cefepime. CONCLUSIONS: Aeroccocus urinae is common genitourinary pathogen that is widely underreported as a cause of septicemia given difficulties obtaining positive urine cultures. Intensivists should consider systemic infection with A. urinae in patients with positive urinalysis but negative urine cultures. Reference #1: Rasmussen, M. “Aeroccocus: an increasingly acknowledged human pathogen.” Clin Microbiol Infect. 2016 Jan;22(1):22-27. Reference #2: Rasmussen, M. “Aerococci and aerocccal infections.” J Infect. 2013 Jun;66(6):467-74. Reference #3: Senneby, E., Petersson, A.C., Rasmussen, M. “Clinical and microbiological features of bacteraemia with Aerococcus urinae.” Clin Microbiol Infect. 2012 Jun;18(6):546-50. DISCLOSURES: No relevant relationships by Matthew Durst, source=Web Response No relevant relationships by Peter Nauka, source=Web Response

Identification of two abundant Aerococcus urinae cell wall-anchored proteins

Aerococcus urinae is an emerging pathogen that causes urinary tract infections, bacteremia and infective endocarditis. The mechanisms through which A. urinae cause infection are largely unknown. The aims of this study were to describe the surface proteome of A. urinae and to analyse A. urinae genomes in search for genes encoding surface proteins. Two proteins, denoted Aerococcal surface protein (Asp) 1 and 2, were through the use of mass spectrometry based proteomics found to quantitatively dominate the aerococcal surface. The presence of these proteins on the surface was also shown using ELISA with serum from rabbits immunized with the recombinant Asp. These proteins had a signal sequence in the amino-terminal end and a cell wall-sorting region in the carboxy-terminal end, which contained an LPATG-motif, a hydrophobic domain and a positively charged tail. Twenty-three additional A. urinae genomes were sequenced using Illumina HiSeq technology. Six different variants of asp genes were found (denoted asp1-6). All isolates had either one or two of these asp-genes located in a conserved locus, designated Locus encoding Aerococcal Surface Proteins (LASP). The 25 genomes had in median 13 genes encoding LPXTG-proteins (range 6–24). For other Gram-positive bacteria, cell wall-anchored surface proteins with an LPXTG-motif play a key role for virulence. Thus, it will be of great interest to explore the function of the Asp proteins of A. urinae to establish a better understanding of the molecular mechanisms by which A. urinae cause disease.

Mitral Valve Endocarditis with Perforation from a Urinary Source: An Unusual Case and Literature Review

Aerococcus urinae (AU) is a rare pathogen, identified as gram-positive, catalase-negative coccus that grows in pairs and clusters which has been reported to mainly cause urinary tract infections (UTI), especially in elderly males. Treatment for this microorganism is usually with beta-lactams although cultures with antibiotic susceptibility testing are imperative. We present a case of AU endocarditis initially treated with IV antibiotics; nevertheless, the patient required emergent mitral valve replacement due to severe mitral insufficiency and perforation. We also present an analysis with high-yield points summarizing epidemiology, risk factors, microbiology, clinical features, diagnostic workup, and management of AU in general and AU endocarditis. Finally, we post a literature review of relevant cases and the impact of different variables associated with it.

298 - Evaluating Aerococcus urinae infection of the urinary tract in a mouse model

298 - Evaluating Aerococcus urinae infection of the urinary tract in a mouse model

Reducing the time between inoculation and first-read of urine cultures using total lab automation significantly reduces turn-around-time of positive culture results with minimal loss of first-read sensitivity.

In order to realize the full potential of total laboratory automation (TLA) in the clinical microbiology laboratory, workflows must be optimized to match each laboratory's capabilities, patient population, and staffing model. Using TLA-based digital photography to monitor urine cultures, we sought to improve culture result turn-around-time (TAT) by changing the time at which a culture is first photographed and thus available for analysis/work-up (Pre1) from 18h (16,391 cultures) to 16h (53,113 cultures) (with a total of 24-h culture incubation in both time periods); in both time periods, cultures were set up 24/7, and culture work-up occurred during the day shift only. With this change, we observed a significant decrease in time-to-final-result TAT for positive cultures (18h-Pre1 median: 71.6h; 16h-Pre1 median: 61.0h). This effect was most pronounced for Gram-negative organisms, with a median reduction in time-to-final-result for Escherichia coli cultures (51.8% of positive urine cultures) of 14.2h (18h-Pre1 median: 77.3h; 16h-Pre1 median: 63.1h). This reduction in TAT was accompanied by a decrease in sensitivity at the Pre1 time point (18h-Pre1 91.01%; 16h-Pre1 88.06%), which we also found to vary by species: there was a reduction in sensitivity at the first culture reading of 1 to 2% for cultures with Gram-negative microorganisms, but for some Gram-positive microorganisms (e.g., Aerococcus urinae and non-aureus Staphylococcus species), there was a reduction in sensitivity at the Pre1 time-point of 3 to 7%. These results can guide workflow decisions for laboratories seeking to implement and/or optimize TLA systems, demonstrating a tradeoff between TAT and the sensitivity of preliminary urine culture results.